Deaths during dental treatment or as a result of dental treatment are rare, but the unfortunate fact is that such deaths do occur. Unexpected death of a patient can be emotionally draining and even harrowing to his or her relatives. The death of a patient may bring an enormous feeling of anxiety both at the personal and professional level, stress, profound grief, damage to self-esteem, loss of self-confidence, reputation, and specter of litigation on a dental surgeon. No dentist can be guaranteed to be free of such an incident during the course of his or her practice. The dentist should respond in a compassionate and respectful manner in case of such unfortunate tragic events, and also ensure self-protection. This article emphasizes on prevention of such incidents and throws some light on how to respond in case of an unfortunate death in a dental clinic, including the medico-legal aspects.

Context: Morphological variation in children can be understood by the knowledge of growth and development. The state of dental development can be used in forensic odontology to ascertain the age of an unidentified child. Aims: This study aims to investigate the relationship of the stages of calcification of the permanent mandibular canine, mandibular premolars, and permanent mandibular first and second molars with skeletal maturity using panoramic and hand–wrist radiographs. Settings and Design: This descriptive work was designed as a cross-sectional study. Materials and Methods: The study was conducted on 300 healthy subjects (150 males and 150 females) ranging 7–20 years of age. Demirjian's method and Bjoörk, Grave, and Brown's method were used to correlate teeth calcification and skeletal maturity, respectively. Statistical Analysis Used: Descriptive statistics and Spearman's rank correlation coefficient were used. Results: 1. Correlation coefficients between the skeletal maturity stages and the developmental stages of the five teeth ranged 0.461–0.877 for females and 0.480–0.790 for males. 2. The second molar showed the highest and the first molar showed the lowest relationship for female and male subjects in the Indian population.
Conclusions: The findings of this study indicate that tooth calcification stages might be clinically used as a maturity indicator of the pubertal growth period.

Background and Aims: Gender estimation is a very important part of a study in the field of anthropology and forensic sciences. In the skeleton, gender estimation is the first step of the identification process as subsequent methods for age and stature estimation are sex-dependent. Skeletal components such as the pelvis and skull are investigated for gender estimation and the mandible is a practical element to analyze sexual dimorphism in fragmented bones. The aim of the present study is to measure, compare, and evaluate various measurements of the mandibular ramus, observed in digital orthopantomographs and also to assess the usefulness of the mandibular ramus as an aid in gender estimation. Materials and Methods: A radiographic retrospective study was conducted using 80 digital orthopantomographs to measure, compare, and evaluate the measurements of the mandibular ramus such as maximum ramus breadth, maximum ramus height, and coronoid heightusing Planmeca ProMax® digital machine to assess the usefulness of mandibular measurements in gender estimation. Results: Descriptive statistics of various measurements and associated univariate F ratios for both the sexes were determined. Four variables were significant predictor in classifying a given sample (P < 0.001). The F-statistic values indicated that measurements expressing the greatest sexual dimorphism were noticed in the maximum ramus height. Conclusion: Mandibular ramus can be considered as a valuable tool in gender estimation and the most reliable measurements were obtained of linear objects in the horizontal plane by digital panoramic imaging.

Objective: Comparative evaluation of the location of mental foramen in different age groups. Determine the variation in position of mental foramen with gender using digital panoramic radiography. Materials and Methods: Digital panoramic radiographs of 250 patients were reviewed. The study population was divided into five age groups with 50 patients each. Radiographic position of mental foramen was evaluated in each radiograph based on three parameters. Measurements were taken in each radiograph using Planmeca Dimaxis pro version 4.4.0 (Helsinki, Finland). The collected data were subjected to statistical analysis using paired Student's t-test. Results: The mean distance of position of mental foramen showed a significant variation within the five age groups. In the first group, female patients showed an increase in mean distance of mental foramen position in relation to three parameters. From the second to fifth groups, male patient showed an increase in the mean distance of mental foramen position. The first and fifth group showed a reduced mean distance of mental foramen position when compared to other age groups. Conclusion: This study concluded that the position of mental foramen varies with age. There was a gender-related variation in position of mental foramen within the population too.

Background: All humans have an identity in life; compassionate societies require this identity to be recognized even after death. Objectives: To measure the dimensions of the mandibular canine and assess the usefulness of the mandibular canine as an aid in gender estimation.Materials and Methods: The study population comprised 200 subjects inclusive of 100 males and 100 females with an age range of 18–25 years. Measurements made in mm at the contact point were of mesiodistal width of the right and left canines and intercanine distance both intraorally and on casts, and the mandibular canine index (MCI) was calculated. The obtained data were subjected to t-test/Mann-Whitney test and discriminant function analysis. Results: All parameters of mandibular canines, namely, intercanine distance, canine width, and canine index were greater in males compared to females suggesting significant sexual dimorphism of mandibular canines. On subjecting the data to discriminant function analysis, it classified sex correctly in 73% of the samples. Conclusion: The result of our study establishes the existence of significant sexual dimorphism in mandibular canines. We can therefore, recommend the use of mandibular canine dimensions as an applicable and additional method for gender determination in human identification.

Aim: The aim of this study was to observe and record the macroscopic, radiographic, and microscopic findings obtained after subjecting the teeth to high temperatures. Materials and Methods: An in vitro study was conducted to observe macroscopic, radiographic, and microscopic changes in dental hard tissues in 60 unrestored non carious extracted human teeth. The teeth were grouped based on age: Below 30 years, 30–40 years, and above 40 years The teeth from each age group were further divided into five subgroups, and each subgroup was subjected to a particular temperature: 200$#176;C, 400$#176;C, 600°C, 800°C, and 1000°C. [C = Celsius]. Results: Various degrees of changes in relation to temperature were observed macroscopically, radiographically, and microscopically. The histological examination was limited for teeth exposed to 200°C. Conclusion: This investigation was carried out to study the gross changes, radiographic changes and histological changes in dental hard tissues exposed to high temperatures, which is an important part of forensic science. The aforementioned alterations caused by heat may provide useful information about temperature ranges and duration of exposure to high temperatures.

Aims and Objectives: (1) To determine the usefulness of mandibular ramus as an aid in sex determination. (2) To evaluate Anteroposterior,superioinferior angle of mandibular condyle. Materials and Methods: A retrospective study was conducted using orthopantomographs of 60 males and 60 females,which were taken using Kodak 8000C Digital Panoramic and Cephalometric System (73 kVp, 12 mA, 13.9 s). The age group ranged between 18 – 45 years. Mandibular ramus measurements were carried out using Master View 3.0 software. The measurements of the mandibular ramus will be subjected to Discriminant function analysis. Results: Maximum ramus breadth, Minimum ramus breadth, Condylar height, Projective height of ramus Coronoid height were calculated for both the sexes differently with the formula & analyzed with Discriminant function analysis using Fischer exact test. The P value was statistically significant with the P value < 0.05 for the following parameters Max. ramus breadth, Condylar height and Projective height of ramus. Conclusion: Mandibular ramus measurements can be a useful tool for gender determination.

Introduction: Sex determination is a vital step in reconstructing an individual profile from unidentified skeletal remnants. Variations in tooth size are influenced by genetic and environmental factors. Tooth size variations have been reported among different populations. Aim: To identify the sex by determining the mesiodistal (MD) dimensions of maxillary canines. Objectives: (1) To compare the MD diameter of all maxillary canines — (a) in the entire urban and tribal population, (b) in urban male and urban female populations, (c) in tribal male and tribal female populations, and (d) in the entire male and female populations and (2) To estimate the percentage of sexual dimorphism individually in urban and tribal populations. Materials and Methods: Fifty subjects each from urban and tribal populations in equal gender ratio were selected in Khammam district, Telangana, for the purpose of this study. After obtaining informed consent, maxillary study models of the selected subjects were made. MD diameters of left and right maxillary canines were measured on casts using vernier calipers. The obtained data were subjected to statistical analysis. Results: (1) The total tribal population showed a greater MD diameter of maxillary canines than the total urban population, (2) Urban males showed a greater MD diameter of maxillary canines than urban females, (3) Tribal males showed a greater MD diameter of maxillary canines than tribal females, (4) The entire male population showed a greater MD diameter of maxillary canines than the entire female population, and (5) The percentage of dimorphism between males and females in individual groups was found to be significant. Conclusion: The study showed maxillary canines exhibiting significant sexual dimorphism and can be used as a distinguishing trait for sex determination along with other procedures.

Identification of humans, especially in mass disaster is a challenging aspect for team members of the disaster victim identification (DVI) unit. Identification is necessary for humanitarian and emotional reasons and for many legal issues, particularly for family members. In the modern day, all possible methods have been applied for establishing the identification of deceased individuals. The DVI team comprises specialists from different disciplines. The forensic dentist plays a major role in the identification of victims in disaster. To establish a simple, faster and time saving procedure for Postmortem dental identification in mass disaster. In this article, we present a simpler and faster method, which helps in gaining access into the oral cavity that helps in the recording of postmortem oral findings where required.

Background: Stature is considered to be one of the “big fours” in forensic anthropology. Though Carrea's Index was published as early as 1920 it has not been validated in any other population apart from the Brazilians.Aim: The present study was conducted to validate Carrea's index in stature estimation in two different racial populations in India.Materials and Methods: The study was carried out in a sample of 100 persons comprising of 25 Aryan males, 25 Aryan females, 25 Dravidian males, and 25 Dravidian females in the age group of 18–30 years. The maximum and minimum stature of all individuals was estimated by Carrea's Index. The actual stature was measured by an anthropometer. The estimated stature was compared with the actual stature and percentage of success was calculated.Results: The Carrea's Index was found to be valid in predicting the stature of 80% Dravidian and 84% Aryan males, the difference being statistically insignificant (Fisher Exact test–0.16; P = 0.99). The stature of 76% of females in both Aryan and Dravidian races was successfully predicted by Carrea's index. Regression analysis showed that the minimum estimated height was more valid in estimating the stature of Aryan and Dravidian population.Conclusion: The validity to use Carrea's index in Aryan and Dravidian population was evaluated and found to be valid.

Context: Thermal insult is the major cause of thermal injury or death and in case of death due to thermal injury the body often has to be recovered from the site. Histologically, one can predict whether the victim was alive or dead when the fire was on going. However, determination of probable cause of thermal insult to which victim subjected to be difficult when the victim's body is found somewhere else from the crime scene or accident site or found alone. Hence, histopathological evaluation of the tissue which has undergone thermal insult in such conditions could help to place evidence in front of law officials, regarding probable condition, or scenario at time of burn of victim. Aims: Keeping this as a criteria in this study we aim to evaluate burnt tissue histopathologically, that undergone various degree of thermal insult, which simulates various real life scenario for mortality in burn cases. Settings and Design: We evaluate the changes in hematoxylin and eosin staining pattern of tissue which has undergone thermal insult compared to normal tissue and also the progressive changes in staining pattern, architectural, and cellular details. Methods and Material: Samples were taken from the patients, in various surgical procedures. Each sample was cut into five parts with close margins so that each burnt tissue is evaluated for same field or region. The tissue that obtained was immediately subjected to varying degree of temperature over a specific period so as to simulate the various real-life condition. Then the tissues were fixed, processed, and stained with routine H and E staining. The processed slides of tissue were examined under the microscope, and the staining, and architectural changes were evaluated and described. Results: Results show that there was a progressive changes in the architectural pattern of the epithelium and connective tissue showing cleft formation and vacuolization, staining pattern also shows mixing of stains progressively as the severity of thermal insult increases.

Background: The Ricketts' posteroanterior (PA) cephalometry seems to be the most widely used and it has not been tested by multivariate statistics for sex determination.Objective: The objective was to determine the applicability of Ricketts' PA cephalometry for sex determination using the logistic regression analysis. Materials and Methods: The logistic models were estimated at distinct age cutoffs (all ages, 11 years, 13 years, and 15 years) in a database from 1,296 Hispano American Peruvians between 5 years and 44 years of age. Results: The logistic models were composed by six cephalometric measurements; the accuracy achieved by resubstitution varied between 60% and 70% and all the variables, with one exception, exhibited a direct relationship with the probability of being classified as male; the nasal width exhibited an indirect relationship. Conclusion: The maxillary and facial widths were present in all models and may represent a sexual dimorphism indicator. The accuracy found was lower than the literature and the Ricketts' PA cephalometry may not be adequate for sex determination. The indirect relationship of the nasal width in models with data from patients of 12 years of age or less may be a trait related to age or a characteristic in the studied population, which could be better studied and confirmed.

Objective: To determine and compare the accuracy of pulp/tooth ratio method in mandibular first and second molar teeth in forensic age estimation. Materials and Methods: A total 300 panoramic radiographs of the Gujarati population (187 males and 113 females) were studied. The measurements of Pulp Chamber Height (PCH) and Crown Root Trunk Height (CRTH) were performed on the mandibular first and second molar teeth. The acquired data was subjected to correlation and regression. Results: The pulp chamber crown root trunk height ratios (PCTHR) of both the first (r = −0.609) and second molars (r = −0.422) were significantly correlated with the age of the individual. Individual regression formulae were derived for both the teeth which were then used separately to calculate the age. The standard errors estimate (SEE) for the first and second molars were 8.84 years and 10.11 years, respectively. There was no statistically significant difference between chronological and calculated age by both the teeth (P = 1.000). Conclusion: The mandibular first and second molar is a potential tool for age estimation in forensic dentistry. The pulp/tooth ratio of both the teeth is a useful method for forensic age prediction with reasonable accuracy in the Gujarati population.

Objective: This study was done with the following objectives: to estimate dental maturity using the Demirjian Index (DI) for the mandibular third molar; to investigate the relationship between dental maturity and skeletal maturity among growing patients; to evaluate the use of the mandibular third molar as an adjunctive tool for adolescent growth assessment in combination with the cervical vertebrae; to evaluate the clinical value of the third molar as a growth evaluation index.Materials and Methods: Samples were derived from panoramic radiographs and lateral cephalograms of 615 subjects (300 males and 315 females) of ages ranging 9-18 years, and estimates of dental maturity (DI) and skeletal maturity [cervical vertebrae maturation indicators (CVMI)] were made.Results: A highly significant association (r = 0.81 for males and r = 0.72 for females) was found between DI and CVMI. DI Stage B corresponded to Stage 2 of CVMI (prepeak of pubertal growth spurt) in both sexes. In males, DI stages C and D represent the peak of the pubertal growth spurt. In females, stages B and C show that the peak of the pubertal growth spurt has not been passed. DI stage E in females and DI Stage F in males correlate that the peak of the pubertal growth spurt has been passed. Conclusion: A highly significant association exists between DI and CVMI. Mandibular third molar DI stages are reliable adjunctive indicators of skeletal maturity.

Introduction: The role of a dentist is not only to examine and treat the oral diseases but also to assist the legal authorities by means of its branch—forensic odontology. Through forensic odontology, a dentist plays a very important role in crime investigation of any type. Objective: To analyze the knowledge, awareness, and interest of forensic odontology among the dental teaching staff who are working in the dental colleges within the Delhi NCR. Materials and Methods: A questionnaire of 12 questions (both open-ended and close-ended) was prepared and the survey was conducted with 200 dental teaching staff. Results: A sufficient knowledge but poor awareness and interest among the dental teaching staff was observed. Conclusion: The study highlighted that although dental teaching staff themselves have sound knowledge regarding forensic odontology, their awareness and interest need to be upgraded on a regular basis. The success of acquiring such extensive knowledge would be valid if better job opportunities in these fields would be increased.

Context: Estimation of time passed since death continues to be a major problem for the forensic pathologist and its determination plays an important and vital role in medico-legal cases. The histological studies on various tissues after death have been mostly confined to single organ or tissue by individual workers at different atmospheric conditions. Aims: The aim of this study is to determine the best rehydrating solution for dehydrated tissues in postmortem examination. Settings and Design: This study was specific to salivary gland tissues and certain pattern of changes were determined during postmortem time intervals using hematoxylin and eosin stain and special stains like mucicarmine and alcian blue. Materials and Methods: The study was divided into two groups. (1) Group A: Normal tissue samples (twenty normal salivary gland tissue samples left without fixation for varying periods of time). (2) Group B: Control group (twenty normal salivary gland tissue samples immediately fixed in formalin). The three different rehydrating agents used in this study were glycerol, normal saline and modified Ruffer solution. Statistical Analysis Used: Not required. Results: Modified Ruffer solution is the best when compared to glycerol and normal saline for rehydration of dehydrated tissues. Conclusions: Thus in our study we conclude that the tissue which had been dehydrated at the crime scene for a fairly long period showed better rehydration with modified Ruffer solution and yield good cellular and nuclear details.

Introduction: Conventional methods to estimate the time of death are adequate, but a histological method is yet unavailable to assess postmortem interval (PMI). The autolytic changes that occur in an unfixed antemortem gingival tissue which reflects histologically at an early stage are similar to changes that occur in postmortem tissue. These histological changes can be used and applied in a postmortem tissue as a method to assess PMI. Aims: The aim of the study is to assess the histological changes in a gingival tissue left unfixed for various time intervals and to correlate the findings with duration. Materials and Methods: Sixty gingival tissues obtained from patients following therapeutic extractions, impactions, gingivectomy and crown lengthening procedures were used. Each tissue obtained was divided into two pieces and labeled as “A”, the control group and “ B” the study group. Tissues labeled “A” were fixed in 10% formalin immediately and tissues labeled“B” were placed in closed containers and fixed after 15, 30, 45 min, 1, 2, and 4 h time interval. Of the sixty tissues in the study group “ B”, ten tissues were used for each time interval under investigation. All the fixed tissues were processed, stained, assessed, and analyzed statistically using Pearson correlation and regression analysis. Results: Histological changes appear at 15 min in an unfixed antemortem tissue. At 2 h interval, all layers with few cells in basal cell layer are involved. At 4 h interval, loss of stratification and complete homogenization of cells in the superficial layers with prominent changes in basal layer is evident. There was a positive correlation (<1.0) between the time interval and the appearance of the histological changes.Conclusion: Histological changes such as complete homogenization of cells in superficial layers and loss of epithelial architecture at 4 h in unfixed antemortem tissue may be used as a criterion to estimate PMI, after further studies on postmortem tissues.

Introduction: Age estimation is important for administrative and ethical reasons and also because of legal consequences. Dental pulp undergoes regression in size with increasing age due to secondary dentin deposition and can be used as a parameter of age estimation even beyond 25 years of age. Kvaal et al. developed a method for chronological age estimation based on the pulp size using periapical dental radiographs. There is a need for testing this method of age estimation in the Indian population using simple tools like digital imaging on living individuals not requiring extraction of teeth. Aims and Objectives: Estimation of the chronological age of subjects by Kvaal's method using digital panoramic radiographs and also testing the validity of regression equations as given by Kvaal et al. Materials and Methods: The study sample included a total of 152 subjects in the age group of 14-60 years. Measurements were performed on the standardized digital panoramic radiographs based on Kvaal's method. Different regression formulae were derived and the age was assessed. The assessed age was then correlated to the actual age of the patient using Student's t-test. Results: No significant difference between the mean of the chronological age and the estimated age was observed. However, the values of the mean age estimated by using regression equations as given previously in the study of Kvaal et al. significantly underestimated the chronological age in the present study sample. Conclusion: The results of the study give an inference for the feasibility of this technique by calculation of regression equations on digital panoramic radiographs. However, it negates the applicability of same regression equations as given by Kvaal et al. on the study population.